Some people become lifesavers while others flee the scene, as writer Darci Picoult found out after a cancer diagnosis. Her body has healed, but it's harder to repair those broken friendships.

I call them my tribe. A group of friends whom I rely on in the toughest or most joyous of moments. Need a shoulder to sob on? They're there. Need to raise a glass? They pop the cork. When I was faced with vulvar cancer several years ago--an experience I chronicled in this magazine in early 2011--they came out in force. They were my tonic, my backup, my if you need anything, just call pals. Similarly, they know that I would be there for them if a crisis shook their world.

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But here's what I learned: Not everyone jumps into action so easily. I realized this when I visited my husband's family a few months after having surgery. Though I had been in close contact with Larry's parents--who called weekly and put me on a prayer list at their East Texas church--I hadn't spoken to his sister, Darla, or her extended family about my medical ordeal. I looked at this visit as a chance to reconnect. Three generations were gathering for the first time in two years. There were babies to squeeze and a life to honor: Larry's dad had recently suffered a heart attack and a collapsed lung. While I packed, I prepared to talk to everyone about his surgeries, as well as my own. I imagined the questions they'd ask and how I'd answer, envisioned heartfelt conversations about all we'd gained and lost. That vision evaporated when I got to Texas and no one said a word.

Polite, painful silence

Were they trying to do me a favor? Cancer is never easy to talk about, particularly when it attacks such a private part of your body. Still, I hoped for a euphemistic "How's your health?" That never came. Maybe I shouldn't have been surprised. I've known Larry's family for over 20 years, and our conversations have almost always revolved around the daily minutia of life. Most times, I savored our visits as a vacation from my usual talkative self. This time was different. I had survived cancer, had peered over the ledge of my life. I craved a connection. But the more I tried to reach into their lives--asking questions about their work or weekend activities, anything to stimulate a discussion--the more they withdrew. I became a walking barometer, gauging each of their reactions as a reflection of what I meant, or didn't mean, to them. These are loving people, I thought. How could they have such little interest in what I've been through? Had the intimate nature of my cancer made them that uncomfortable, or was this another side effect of a serious illness: loved ones going AWOL when you need them most?

No, it's not contagious

When I got home, I started asking those questions in conversations with friends and colleagues who'd been through similarly major medical ordeals. The first woman I talked to, Maia*, discovered a lump in her breast and was diagnosed with an early cancer. She opted for a double mastectomy to prevent any future threats, a radical decision that she shared with a select group of close friends. One of them neglected to call Maia in the weeks leading up to her surgery, so Maia picked up the phone and called her--and went straight for the punch: "Why haven't you contacted me?" After a moment of silence, her friend responded, "I'm not very good at this sort of thing." Maia didn't flinch. "Then get good," she replied. Her directness prompted her friend to confess her fear of physicians and illness. "I knew she was emotionally avoiding me," Maia said, "but I had no idea that it was because she was scared of doctors, so much so that she hadn't gone to one in years. She told me I'd become the embodiment of her greatest fear. If this happened to me, it could happen to her."

The Los Angeles--based comedian and writer Annabelle Gurwitch told me that her first instinct was to shield her friends from that very fear when her son, Ezra, was born with VACTERL: an acronym for a constellation of rare birth defects. The diagnosis instantly beamed Annabelle and her husband into what they call an "alternate universe, the world of parents with sick children." When Annabelle brought Ezra home, she recalls, "anyone who was pregnant or could be pregnant in this lifetime called with concern. I answered all their questions and told them everything they wanted to know, then didn't hear from them for years." Annabelle takes a breath. "Except for an intrepid few." With those remaining friends, she tried a new tack. She'd tell them, "Statistically speaking, the fact that it happened to my child means it won't happen to yours." "They felt better," says Annabelle, "but it was a lie! I made it up so they wouldn't ditch the relationship out of nerves."

"Some people need to believe they'll always have perfect health and perfect children," says Owen Lewis, M.D., a clinical professor of psychiatry at Columbia University, when I relayed Annabelle's story. "They don't want to be part of someone else's illness or crisis." Soon after, Vivian Ubell, a licensed clinical social worker who guided me through my cancer, told me, "People tell you what they're able to handle by their response. Some welcome specifics. Others ask questions to pry. And others shy away from specifics because it makes them uncomfortable and scared." And we're just supposed to be Zen about it? "This is family," I countered. "All I wanted was an expression of interest." Ubell nodded. "Not asking is the way some people normally behave. They think it would be impolite to ask unless you bring it up." She had a point. Maybe Larry's family believed they were honoring my privacy. "You must accept that people handle crises differently," she said.

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"It's all about empathy," said Annabelle. "When people dropped out of my life, it made me angry. And I love being angry. But I realized I couldn't live like that." Ultimately, Annabelle learned to accept, not resent, that it was difficult for some people to face Ezra's illness--be it out of loving concern or fear--and she found the kinship she needed in support groups for parents of disabled children.

Can we rebuild?

Maia, the woman who had a double mastectomy, took a different tack: "Sometimes you have to teach a friend how to be a better friend," she says. "I told my friend to 'get good' because I wasn't willing to lose the relationship." That talk led to an afternoon of retail therapy, followed by a hospital visit after Maia's surgery. "I knew it was hard for her," she says. "But she stayed. That meant the world."

Inspired by Maia's straightforwardness, I wrote to Larry's family three months after the Texas trip. "I understand that questions about someone's health may be difficult to navigate," I said. "I am not asking for a deep conversation... but how fantastic an expression of interest would be." Only a few relatives responded. One niece wrote, "I didn't say anything because I thought you didn't want to talk about it." Larry's sister, Darla, wrote back months later: "I assumed you would bring it up if you wanted to tell me about it." And a nephew in his mid-30s wrote with an honesty that took my breath away. "I try not to push my problems onto others unless they ask. In turn, I don't have a habit of asking others about their feelings or problems either." I swallowed each word slowly in an effort to digest his response, one that was antithetical to who I am as a person. I wrote back, "As a women of many words writing to a man of few words, I hope that one day, we can find some words."

A year later, Larry and I ventured back to Texas, buoyed by what I'd learned while writing this article. I knew that whatever happened, I wanted to rekindle my relationship with his family. One of the nights happened to be the Jewish new year, and Darla did something I found touching: She downloaded Hebrew prayers and asked to learn them with me. My nephew of few words and I watched his toddler tumble across the carpet. Laughter spread like wildfire through the house. But still, no one mentioned my medical ordeal. I contemplated saying something, but feared that no matter how casual the language, I would undo the ease that had permeated the house. Besides, there had been a shift in my in-laws, from absence to engagement, and I wanted to meet them halfway.

Our last night there, Larry's mom suggested we eat at the new Italian place in town. We sat at a long table and passed baskets of bread to each other, and as the conversation bounced from person to person, I could feel our collective breath fill the room. I hesitated for a moment, then raised my glass. Everyone's eyes turned to me. "To a healthy year," I said.

A few months after that visit, I had to have more surgery. I called Larry's parents to tell them the news. The next night, the phone rang. "How are you?''

"Fine," I said, touched that Larry's mom had called again.

"Dad tells me you're going back to the hospital."

I stifled a small gasp. It wasn't my mother-in-law. It was Darla. My heart filled with an unexpected thrill. Words rushed out of my mouth. And for the next 20 minutes or so, we talked.

3 Ways to Help a Friend When You Don't Know How to Help

1. DO SOMETHING FROM A SLIGHT DISTANCE. Send a meal or run an errand. Pick up the phone or write an email. Even if you say just a few words, it allows for a connection.

2. DON'T OFFER UNSOLICITED ADVICE. Most patients are bombarded with opinions from medical experts and family members, so think twice before giving your own. Once, when I met a friend for a drink during my treatment, she told me my problem was my aura. The color was off, according to her. Not helpful.

3. ENLIST A NETWORK OF FRIENDS. Therapist Vivian Ubell cites a case in which a husband couldn't bear to be present during his wife's cancer treatments and asked friends to take turns accompanying her to the sessions. She understood his avoidance of that part of her treatment. "A patient's illness can be just as stressful for his or her caretaker," Ubell says. "It is quite normal for a caretaker to have limitations." Fill one of those gaps and you'll show your love for both of them.